甲状旁腺功能亢进症性骨病26例分析  

Strategy for the diagnosis and treatment of bone diseases caused by primary hyperparathyroidism

作　　者：桑尚 张智长[1] 覃澍 张靖[1] 董扬[1] SANG Shang ZHANG Zhi-chang QIN Shu ZHANG Jing DONG Yang.(Department of Orthopedics, the sixth People＇s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233, PR)

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《中国骨与关节杂志》2016年第9期690-694,共5页Chinese Journal of Bone and Joint

摘　　要：目的探讨甲状旁腺功能亢进（hyperparathyroidism,PHPT）导致骨病的诊疗策略。方法回顾本中心诊治的26例PHPT骨病患者的临床资料,其中男6例,女20例,年龄13-83岁,平均50岁。26例症状均有骨痛,其中6例合并活动障碍,5例合并乏力。结果术前,本组26例中23例血钙均高于正常,为2.65-l4.28 mmol/L,平均3.00 mmol/L。26例中,16例血磷正常,10例均低于正常（0.53-0.77 mmol/L,平均0.61 mmol/L）。26例甲状旁腺素（PTH）均高于正常（105-2361 ng/L,平均651.88 ng/L）,15例行X线平片检查,3例无明显异常;12例呈骨密度减低,5例出现骨皮质吸收。所有患者均转入普外科行甲状旁腺腺瘤切除术,1例术后行刮除植骨内固定术,1例术后骨折行切开复位内固定。术后随访半年至2年,1例术后发生骨折,其余25例均无骨折发生,25例骨痛明显改善,VAS评分均〈3分,骨痛明显改善所需时间为3天至1年半。结论对骨痛、病理性骨折的患者,应加以怀疑PHPT的可能,完善并密切关注血钙及PTH检查结果,结合甲状旁腺超声及骨骼相关的影像学检查,可确诊此病。经普外科切除甲状旁腺腺瘤后,长期随访此病预后较好,并发症少。Objective To summarize the strategy for diagnosis and treatment of bone disease caused by primary hyperparathyroidism（ PHPT）. Methods The clinical data of 26 patients with PHPT treated in our hospital were analyzed; 6 were male and 20 female. Their mean age was 50 years（ ranging from 13 to 83）. All of the 26 patients had symptoms of pain, including 6 patients with movement disorders, 5 patients with fatigue. Laboratory examination showed that the patients had hypercalcemia, hypophosphatemia and raised parathyroid hormone（ PTH）. Skeletal imaging examination showed decrease in bone density, cystic bone absorption and absorption in phalangeal cortical bone. All patients were transferred to the Department of General Surgery for parathyroid adenoma resection. After the surgery, 1 patient was treated with nidus curettement, bone graft and internal fixation and 1 patient with postoperative fracture was treated with open reduction and internal fixation. Results There were significant pain relief in 25 patients（ the VAS scores were less than 3 points） and the time required for the relief of pain ranged from 3 days to 1.5 years and most of the patients need less than 6 months. One patient got fracture, the rest of the patients had no fractures. Conclusions Patients with bone pain, pathologic fractures should be suspected of PHPT. Further examination, such as the level of serum calcium and PTH and parathyroid ultrasonography and skeletal imaging examination, can help the diagnosis. After the resection of the parathyroid adenoma, the long term prognosis of patients with PHPT is favorable and the complications are rare.

关 键 词：甲状旁腺功能亢进 骨密度 骨病医学 高钙血症 

分 类 号：R582.1[医药卫生—内分泌] R68[医药卫生—内科学]